Essex County Community Asthma Care Strategy

1. Dorothy Pardalis, BSc.Phm. C.A.E. Proactive Health Strategies Inc. Essex County Community Asthma Care Strategy “A proactive community response to a global healthcare challenge”

2. Cost of Asthma in Ontario • Annual cost $2,550 / annum (1995) • ($1,255 to $5,032) • Direct costs 50.2% • Physician visits, Lab, Hospitalization, Prescriptions • Hospitalization and medication each 22% • Indirect costs 49.8% • Absence from work or usual activity • Travel and waiting time • Ungar WJ Can. Resp. Journal 1998;5:463-471

3. Cost of Asthma in Ontario Cost ($)

4. Asthma 2 million or 8.4% of Canadians

5. Parameter Daytime symptoms Nighttime symptoms Physical activity Exacerbations Absence from work or school Need for short-acting B2-agonist Frequency or Value < 4 days/week < 1 night/week Normal Mild, infrequent None < 4 doses/week* Asthma Control Canadian Asthma Consensus Report, 1999; 2001 and 2003 Updates *excluding one dose/day to prevent exercise-induced symptoms

6. Canada 28% visited the ER 7% were hospitalized 43% MD visit 50% visited the ER, was hospitalized, or received other emergency care 20% missed school or work in the prior year >70% were not achieving benchmark control Asthma in Canada 2000 - A Landmark Survey Windsor Essex 21% visited the ER 5% were hospitalized 53% MD visit 50% visited the ER, was hospitalized, or received other emergency care 33% missed school or work in the prior year (8.99 days) 60% were not achieving benchmark control Current ECCACS statistics n=672 Health Status of Asthma Patients

7. Preliminary ResultsUtilization Year Prior to Intervention

8. Preliminary ResultsAbsenteeism • Absent from school or work in the past 12 months • 33% of participants • Average number of days missed • 8.99 Days

9. Health Status of Asthma Patients • SYMPTOMS > 4 TIMES WEEKLY IN THE PREVIOUS MONTH • Cough : 46 % • Wheeze : 17 % • Shortness of Breath: 21 % • Chest Tightness: 14 % • Nocturnal Cough: 29 % • Use of Rescue Medicine : 19 % Current ECCACS statistics n=672

10. Preliminary ResultsBaseline Symptom Control

11. Program Model • Individualized education – Primary Care • Initial assessment, follow-up at 1-3 months • Electronic software tool that standardizes the intervention • Self-management education • Effective chronic disease management requires active participation of the patient • Interdisciplinary care • Objective testing: lung function

12. Patient Identification • Primary Care • Look-back program • Emergency Departments • Walk-in Clinics • Employers

13. Self-management Skills • General knowledge of asthma • Understanding of triggers / avoidance • Understanding role of medication in control • Recognition of symptoms / control • Self-monitoring of symptoms / peak flow • Device skills for inhaled medication • Understanding and confidence to enact set of recommendations to adjust medication

14. Asthma Self ManagementAction Plan

15. Target Numbers • 1,500 patient encounters • 390 days of engagement

16. Outcome Analysis • Primary: Improve asthma symptom control three months post-intervention • Secondary: • Reduced healthcare utilization • Reduced asthma exacerbations • Reduced absenteeism • Improved lung function

18. Supporting Organizations • Asthma Research Group • Essex County Pharmacists Association • Hotel-Dieu Grace Hospital • University of Windsor • St. Joseph’s Health Care London • Leamington District Memorial Hospital • DaimlerChrysler

19. Preliminary Data: Patient Satisfaction(n=310)

20. More data to come … Dorothy Pardalis dpardalis@sympatico.ca